Menu

Mental Health

Back in March I wrote an article about PTSD and recognizing the symptoms and a very brief paragraph about how to reach out for help. The other morning we had a call, and I regretted that I had not put more focus on how to provide aid and support for a family member who has PTSD rather than just the symptoms. If you have a family member with PTSD, I need to start by saying I am sorry that I did not give you as much help as I might have.

I do need to provide a link to the original article because recognition of the symptoms are the first step. It can be found here: https://nrhpdmedia.com/tag/ptsd/

Also, I have mentioned a couple of things that I need to bring up again quickly.

First, I have talked about cortisol and how that hormone, a result of stress, has enormous physical and mental consequences when it is not released; This bit of info ties into the next thing I need to refresh us all on.

Second, the amygdala is, along with the thalamus, the part of the brain that deals with fear, stress, and emotion. If the amygdala receives a threatening message from the thalamus, it sends out an emotional response.

Issues arise when cortisol is being continually dumped into the system. The brain begins adding additional connections in these parts which then trigger more depression, anxiety, stress, and hyper-reactivity while simultaneously reducing the ability of the brain to access the prefrontal cortex which is where we do our real thinking. More reactivity, less processing… see where this is heading?

– – – – –

Whew, it sure took me a long time to get to what I said was going to be the focus, didn’t it? Sorry, but I feel like if we understand the “how” and “why ” we can wrap our heads around the “what” to do.

So what do family and friends do when they see someone they care about going through the symptoms we have discussed before?

Well, here is a pretty good list cobbled together from a few different sources:

Learn as much as you can about PTSD. Knowing how PTSD affects people may help you understand what your family member is going through. The more you know, the better you and your family can handle PTSD.

Offer to go to doctor visits with your family member. You can help keep track of medicine and therapy, and you can be there for support.

Tell your loved one you want to listen and that you also understand if he or she does not feel like talking.

Plan family activities together, like having dinner or going to a movie.

Take a walk, go for a bike ride, or do some other physical activity together. Exercise is important for health and helps clear your mind and also helps the body process cortisol.

Encourage contact with family and close friends. A support system will help your family member get through difficult changes and stressful times. People who have PTSD may isolate themselves which will significantly compound the problem.

Practice “mindfulness” or “Loving-Kindness” meditation techniques. It is ok to allow yourself to feel your feelings. Trying to suppress them means they will take control. Sure, maybe this seems pretty “sappy” or “granola, ” but it works. There are many videos on YouTube to guide you through this.

Your family member may not want your help. If this happens, keep in mind that withdrawal can be a symptom of PTSD. A person who withdraws may not feel like talking, taking part in group activities, or being around other people. Give your loved one space, but tell him or her that you will always be ready to help.

What if they get angry or have an outburst? Well, we all know it is nearly pointless to attempt a discussion when someone is overly upset. Here are some pointers:

If anger leads to violent behavior or abuse, it is dangerous. Go to a safe place and call for help right away. Make sure children are in a safe place as well.

It is hard to talk to someone who is angry. One thing you can do is set up a time-out system. This helps you find a way to talk even while angry. Here’s one way to do this.

Agree that either of you can call a time-out at any time.

Agree that when someone calls a time-out, the discussion must stop right then.

Decide on a signal you will use to call a time-out. The signal can be a word that you say or a hand signal.

Agree to tell each other where you will be and what you will be doing during the time-out. Tell each other what time you will come back.

While you are taking a time-out, don’t focus on how angry you feel. Instead, think calmly about how you will talk things over and solve the problem.

After you come back:

Take turns talking about solutions to the problem. Listen without interrupting.

Use statements starting with “I,” such as “I think” or “I feel.” Using “you” statements can sound accusing.

Be open to each other’s ideas. Don’t criticize each other.

Focus on things you both think will work. It is likely you will both have good ideas.

Together, agree which solutions you will use.

Finally, how can you communicate better? We have discussed some of this in the past, but I found this great YouTube video that has the key ways to talk to someone in crisis: The Secrets of Hostage Negotiators.

– – – – –

I hope this helps. Again, it is something I wish I had included the first time around.

Please, don’t ignore a problem. If you have someone who needs help, call someone for help. Me, the VA, a rape crisis center, whomever. Just help that person find help or an outlet.

According to Fortune Magazine, while 96% of American workers say that vacation time is important to them, 54% of them didn’t use their earned time adding up to 662 million hours of vacation time going back to companies. That’s $604 earned dollars we’ve given back to our employers.
Why is this a mental health concern?

Heart disease is the number one killer in the country because of sedentary lifestyles and stress. Stress is significant because of the associated hormone, cortisol, causes a high blood pressure and a buildup of midsection fat and also our view on our lives causing burnout and depression, mental illness and shorter lifespans. Cortisol also causes us to crave fatty and sugary foods.

Many cite affordability as a reason they don’t take a vacation. A vacation doesn’t have to be expensive or extravagant to be effective.

One study in Australia showed that just 30 minutes in nature once a week reduces stress. If you’re here in the DFW area, there are many fantastic nature trails, and many are free or very inexpensive. In North Richland Hills, we have over 30 miles of hiking and biking trails.

Even looking at a picture of a nature scene reduces stress. I recently found a YouTube channel with some beautiful, ultra-high definition videos of nature scenes that run for hours. You can find the link below.

There are also some great apps out there to reduce stress. The one I use comes from calm.com. There is a website and an app which has free and paid options.

Others think that not taking time off makes them look better to their bosses. Statistics show that people who don’t take time off or more likely to be passed over for promotions or raises.

So I’ve made it a point in my life to start getting outside more and doing healthy things to de-stress at the end of each day. Join me?

So taking off and even having a stay-cation is a win/win. Better health, both physical and mental, and it even may get you that raise you so richly deserve.

Traumatic Brain Injuries or TBI’s

Hi all,

Sorry, I have not written anything in a few, but I am generally busier than I wish I were. That said, let’s talk about a different kind of brain issue than my norm. Let’s discuss “Traumatic Brain Injury” or “TBIs.”

TBIs are in the new frequently these days because of the frequency of incidents with our military men and women encountering IEDs and other concussive type mechanisms of injury. However, there are many numerous causes of TBIs that we here in in the US could encounter. In Texas, more than 144,000 people sustain a traumatic brain injury each year, and an estimated 440,000 Texans have a disability related to a traumatic brain injury.

In the US, the number of people who are diagnosed with a brain injury each year is more than the number of individuals diagnosed with Alzheimer’s, breast cancer, HIV/AIDS, prostate cancer, lung cancer, and ALS….combined.

So why is it important to address this issue?

Well, NOT protecting our brains can leave us with lifelong consequences. While some effects can be overcome, some are not. Everything we are, think, know, remember, believe, do, see, hear, taste, etc.… it’s all controlled or stored by our brain. The human brain is not designed to withstand impacts so we need to do what we can to try to avoid injuring it. We could change our very personality by not doing so.

So what are the number one cause of TBIs? Falls. Falls account for 40% of TBIs. Some other reasons are:

concussion

violence

blast injury

struck by or against something

motor vehicle crash

abusive head trauma

shaken baby syndrome

sports injuries

Who is principally at risk?

Children ages 0-4 and Adolescents ages 16-19: most likely to have TBI-related ED visit or hospitalization. (This is due to falls or general risk taking.)

Older adults age 75+: have highest rates of TBI-related hospitalizations and deaths among all age groups. (This is due to falls because of declining mental and physical attributes.)

Domestic Violence Survivors: Studies estimate the prevalence of TBI in domestic violence survivors is over 35%.

Athletes: Over 1.6 million sports and recreation-related concussions occur in the U.S. each year.

Moreover, how do we avoid a TBI? Follow these tips to reduce the risk of brain injury:

Seat belts and airbags. Always wear a seat belt in a motor vehicle. A small child should always sit in the back seat of a car and be secured in child safety seats or booster seats that are appropriate for his or her size and weight.

Alcohol and drug use. Don’t drive under the influence of alcohol or drugs, including prescription medications that can impair the ability to drive.

Wear a helmet while riding a bicycle, skateboard, motorcycle, snowmobile or all-terrain vehicle. Also wear appropriate head protection when playing baseball or contact sports, skiing, skating, snowboarding, or riding a horse.

Preventing falls

The following tips can help older adults avoid falls around the house:

Install handrails in bathrooms

Put a nonslip mat in the bathtub or shower

Remove area rugs

Install handrails on both sides of staircases

Improve lighting in the home

Keep stairs and floors clear of clutter

Get regular vision checkups

Get regular exercise

Preventing head injuries in children

The following tips can help children avoid head injuries:

Install safety gates at the top of a stairway

Keep stairs clear of clutter

Install window guards to prevent falls

Put a nonslip mat in the bathtub or shower

Use playgrounds that have shock-absorbing materials on the ground

Make sure area rugs are secure

Don’t let children play on fire escapes or balconies

However, say something happens, and someone you know ends up with a possible head injury. Here’s what to look for:

SIGNS & SYMPTOMS:

Confusion or disorientation

Loss of consciousness

Severe headache

Nausea or vomiting

Dizziness

Blood or clear fluid draining from nose or ears

Weakness, numbness, or tingling in limbs

Trouble walking

Slurred speech or vision issues

Seizure

Symptoms may not appear until days, weeks, or even months after the injury.

Continue to monitor for signs and symptoms even if you do not observe any immediately. See a doctor if you notice any of these changes after the injury.

COGNITIVE:

Concentration and memory problems

Changes in Work/school performance

Delayed thinking and understanding

BEHAVIORAL/EMOTIONAL:

Changes in personality and behavior

Irritability/Aggression

Depression/Anxiety

PHYSICAL:

Poor balance and coordination

Sleep disturbances or fatigue

Ongoing headaches or neck pain

Sensitivity to light and noise

And finally, consider downloading a wallet card at the link below if you have a brain injury that has left you with permanent symptoms that may complicate your normal life, including an interaction with a police officer. Some symptoms, because of a lack of knowledge about your history, might appear to indicate intoxication or alcohol or another substance. Having a wallet card with easy to understand information may help mitigate a situation.

I hope this information helps. Head injuries are not something we “rub some dirt on and walk off.” It is something to take them all seriously until you are confident it not.

PTSD (Post Traumatic Stress Disorder) is a newer term to describe, though perhaps less well, a condition induced by exposure to extreme psychological or physical trauma.

In World War I, we described soldiers as having “shell shock.” In World War II, it came to be known as “battle fatigue.” During the Korean War, it was “operational exhaustion” and finally came to be PTSD. Does anyone else notice the sterilization and softening of the language used to describe it?

We are talking about the military, and that is probably what most of us think of because of the conflicts we are currently involved in overseas. However, many other things can trigger PTSD.

Rape, sexual trauma, violent incidents, car crashes, domestic abuse, disasters, and so on. All of these things can also trigger PTSD. Moreover, perhaps even more surprisingly, we do not even have to see these things directly. PTSD can occur from having experienced it, been exposed to it, or even having been told about it.

Let’s stick with the combat analogy for a moment. Humans are not designed to hurt each other, although we seem to be exceedingly good at it. If you do not believe that, let’s go through a relatively famous thought experiment known as “The Trolley Problem.”

Imagine yourself standing on a set of railroad tracks. A fast train is coming down the tracks toward a group of people. You notice a switch to send the train onto a second set of tracks, but that will kill a single person standing on them. There is no time for any of course of action. Do you pull the switch?

For many, the quick and easy answer is yes. The loss of one person is preferable to the train killing a group of individuals. Tragic, yes, but logically speaking (for all you Star Trek fans), “The needs of the many outweigh the needs of the few or the one.”

So let’s change up this scenario a touch. The same setup but this time the only way to stop the train is to push the man onto the tracks.

Does this change things? Logically, no. One person dying is still preferable to many dying. And, technically, you are still responsible for the death of the man.

However, does it make a difference in your mind between pulling a switch and having pushed this man to his death? Do you feel differently about whether you could or would do it?

So let’s come back to the experience of trauma. As we attempt to reconcile the traumatic event, some struggle with being able to cope to the point that it interferes with day to day life. Guilt, depression, emotional pain, and soon become overwhelming and lead to symptoms such as:

Re-experiencing symptoms:

Flashbacks

Nightmares

Intrusive thoughts

Avoidance symptoms:

Avoiding places, events, or things associated with the event.

Avoiding thoughts and feelings related to the event, including self-medicating to do so.

Reaction symptoms:

Easily triggered startle reflex.

Feeling tense, anxious, or on edge.

Difficulty sleeping.

Angry outbursts.

Mood / Thinking symptoms:

Memory troubles.

Persistent negativity about oneself or life.

Distorted feelings of guilt or blame.

Loss of interest in things once enjoyed.

So what can be done about PTSD? Well, typically a combination of medications and talk therapies (such as cognitive behavioral therapy) have been found to be the most effective. There is even a treatment that uses eye movement and trauma recollection to reduce the negative emotional impact.

Overall, there is help available for you or loved ones that are having problems dealing with emotional trauma. If you do not know where to start, follow some links below. There are also many local resources that can help.

You have heard it before, and you are about to hear it again. We are here to help. If you or someone you know needs assistance dealing with PTSD, please call me at 817-427-7092. If this is an emergency, CALL 911.

When we see someone switch moods suddenly, we often hear someone say, “Wow, they are so bi-polar.”

The reality is, people with bipolar disorder do not have sudden and unexpected mood swings. That is more typical of borderline personality disorder which we talked about a couple of weeks ago.

People with bipolar disorder instead have longer cycles of mood changes between mania and depression which may cycle anywhere from a few times a year to a few times a month with most cycles lasting at least a week.

During the depressed phase, the person shows all the classic signs of a depression disorder such as feeling hopeless or helpless and having little to no motivation to enjoy things they normally would have.

During the manic phase, the person may show hyperactivity, increased impulsivity, increased risky behaviors, and go days without sleep. Some can even become psychotic during this time and have delusions or hallucinations.

Bipolar disorder also carries an increased risk of suicide with nearly 50% of those with the diagnosis having attempted at some point. The risk of suicide goes up dramatically when bipolar disorder goes untreated.

So what can be done about bipolar disorder? Well, medications such as mood stabilizers and psychotherapy techniques such as cognitive behavioral therapy have shown great success. The key is getting treatment. Treatment can also be difficult as 40% of people with bipolar disorder also have a lack of insight, called anosognosia, which we’ve talked about before as well. This lack of insight makes treatment routines difficult to stay on.

Today I wanted to discuss the struggles that come for those diagnosed with Borderline Personality Disorder (BPD). The symptoms of BPD cause huge struggles for those with the diagnosis, their family, friends, and loved ones.

While women are more frequently diagnosed with BPD than men are (3 to 1), both genders can suffer from it, and the symptoms may manifest themselves differently.

For women, the symptoms may include(1):

Frantic efforts to avoid real or imagined abandonment

A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)

Recurring suicidal behaviors or threats or self-harming behavior, such as cutting

Intense and highly changeable moods, with each episode lasting from a few hours to a few days

Chronic feelings of emptiness

Inappropriate, intense anger or problems controlling anger

Having stress-related paranoid thoughts

Having severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality

For men, the symptoms might be the same or a little different and include(2):

Aggressively thin-skinned

Controlling through criticism

Irrational jealousy

Possessive but detached

Rejecting relationships

Holding grudges

Using sex to relieve insecurity

Substance abuse

These symptoms are difficult to live with both as the one with the diagnosis and others living in the tempest. The person with BPD may cycle rapidly through, “I love you! I hate you! Please don’t leave me!” and all involved struggle to be able to deal with the emotions this cycling causes. The person with BPD is terrified of abandonment and tries so hard to prevent it and in turn, cause it.

Because of this “hole” in their lives, those with BPD often turn to other people and actions to fill the void. They might go on wild spending sprees, have affairs or engage in unsafe sex, or self-medicate with drugs or alcohol.

Sadly, because the amount of “drama” and disarray that BPD brings into their life, people with BPD have a high rate of suicide.

“About 70% of people with BPD will make at least one suicide attempt in their lifetimes. In addition, between 8 and 10 percent of people with BPD will complete suicide; this rate is more than 50 times the rate of suicide in the general population.”(3)

Though this diagnosis is notoriously difficult to deal with without therapy or treatment, there is hope. While there are no medications recommended to treat BPD, there are some talk therapies that can help a BPD sufferer better cope with their beliefs or feelings and temper their responses. These therapies include Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT).

There are also several books that come highly recommended. Do some research and read some reviews to see if one of these might help you understand what is happening and how to go forward on dealing with it.

Recently, Officer Morgan had the opportunity to meet with Ryan, a ten-year-old boy with Autism. His journey with finding his voice is truly incredible, and we were humbled and honored to be interviewed by him.

Officer Morgan writes of their time together:

“Yesterday, I had the incredible good fortune to meet Ryan. At one’s first impression, because he is non-verbal, one might make certain assumptions about his capabilities. I learned that Ryan has more to say than many people I know.

With the use of his letter board, Ryan and his mother Stephanie interviewed me for over an hour. When Ryan let me get a word in, , I asked him this question, “If there were just one thing I could teach officers about their interactions with autistic people, what would it be?” I jotted it down as he spelled it out and I’m attaching a picture as well as a picture of me and Ryan and Freckles, his autism assistance dog.

With recent events, I felt it was timely and important to discuss the impact of suicide on the survivors, such as friends, siblings, parents, and children.

(I want to note that, as of the time of this writing, the cause of death for Mr. Loncar is undetermined. I’m not privy to exclusive information and I’m not any more informed about what happened that the public in general. The incident was simply the catalyst for writing this article.)

– – – – – – – – – – – – – – – – – – – –

Suicide is tragic for everyone involved. We can all agree that it is terrible that someone can reach a point that their ability to cope has been exceeded and they believe the only escape is suicide. But suicide has significant direct and indirect impact on others as well.

People mourning a friend or family who committed suicide, or died suddenly, are 65% more likely to attempt suicide. 80% are more likely to drop out of school or quit work.

Children (< 18) who lose a parent to suicide at an early age are three times more likely to commit suicide. They are also twice as likely to be hospitalized for depression and this applies to other family members as well.

Parents who lose a child to suicide have double the rate of depression for the two years after the death. They also have a 40% increase in anxiety disorders and a 60% increases in other disorders.

“Suicide contagion” is also very real. Analysis shows that at least 5% of youth suicides were influenced by the suicide of someone else, even when they weren’t well known by the person whether someone else at school, work, or a famous person. Some studies showed up to a 12% rise. In one incident, where a fictional subject on a soap opera committed suicide by overdose of acetaminophen, there was a 17% uptick of attempts of real world suicide by overdose using acetaminophen the following week.

Not only are there mental consequences but there are physical consequences as well. Incidents of cardiovascular disease, COPD, high blood pressure, and diabetes all go up. They are 18% more likely to get a divorce. Even that divorce can trigger suicide rates three times higher than average.

– – – – – – – – – – – – – – – – – – – –

As we can see, suicide has a significant impact on everyone and lasting effects on the people left behind. During these hard times, keep an eye on your loved ones for signs that they aren’t coping well. Here is an easy mnemonic device to help you remember what to look for:

Here’s an easy-to-remember mnemonic:

IS PATH WARM?

I IdeationS Substance Abuse

P PurposelessnessA AnxietyT TrappedH Hopelessness

W WithdrawalA AngerR RecklessnessM Mood Changes

As always, we’re here to help and if there is something we, or I, can do to help please don’t hesitate to call us at 911 in an emergency, 817-427-1000 in a non-emergency, or call my office directly at 817-427-7092.

How masculinity affects mental health treatment:

Men are 3.5x more successful at suicide than women, typically because of the methods used. However, it’s the stigmas involved with mental illness that keep men from reaching out for help.

Men are generally raised with the idea that showing emotion isn’t what boys do and they are expected to fight through it or simply “get up, rub some dirt on it, and get moving.” Men are expected to be strong all the time.

Because of this, men don’t often seek the help they need when dealing with an issue. They sometimes won’t even reach out to friends for help because that’s just not what men do. Men are expected to be self-reliant and needing help is sometimes seen as a sign of weakness.

Because of this, reaching out for help is difficult and stigmatized as being a wimp but getting help could also clearly be seen as the very bold step.

If you, or a man in your life, needs help dealing with depression or any other mental illness, http://headsupguys.org/ is an online resource with tips and resources to help men deal with what they are facing. http://www.realwarriors.net/ is an online resource for those men AND women who served in the military and need assistance dealing with the “invisible wounds” they brought home.

Talking through a crisis – LISTEN

Hi all,
For Mental Health Monday, I’d like to talk about talking. Actually, let’s talk about communicating… not at all the same thing. To communicate effectively, it’s more important to be listening which is key to being able to help someone in crisis.
Many of us are guilty of being in a conversation where we aren’t listening. Our brains are engaged not in processing what we are being told but rather churning away on what we want to say on our next chance to talk.

When someone is in crisis, first we need to LISTEN to them and help them burn off that emotional load. Doing this in a controlled way helps keeps them from fueling their own fire. We do that by asking questions and giving replies that bring out and identify what has caused the crisis. For example, “What has happened to make you feel this way today?” When they are telling you, nod your head and reply with “mm hmmm” and “okay” which doesn’t interrupt them but lets them know you are listening. When they pause, you might ask, “It sounds like this made you very sad/hurt/etc.” which helps you both label the emotions they are feeling and, again, lets them know you are listening. Even if you are wrong, it gives them a chance to correct you. Either way, now you know how they feel.

Next, we EMPATHIZE with the person. This doesn’t mean we must agree with what they think or say but we can express something like, “I can understand how that could have hurt you.” This, again, shows the person they are being heard. Let’s say, for example, they are suffering from audible hallucinations like tormenting voices. While we can’t know what it’s like to experience that, we can honestly say, “That must be very frustrating for you.”

By LISTENING and EMPATHIZING, we can help calm a person’s mind and help them become more rational which then let’s us all move toward finding a positive outcome for a situation.
If you’re interested in reading more about verbal de-escalation, you might check out “Verbal Judo” by Dr George Thompson or “In the Eye of the Hurricane: Skills to Calm and De-escalate Aggressive and Mentally Ill Family Members” which can be found at www.edgeworkbooks.com. The book I mentioned last week, “I’m Not Sick, I Don’t Need Help” also talks about this process.